Cervical Manipulation and Vertebral Artery Injury: A Literature Review

Abstract

Understanding the risks and benefits of manipulation of the cervical spine is essential in developing effective and safe intervention strategies for patients with cervical spine pain. A review of the literature was performed to assess the effectiveness, benefits, and risks as well as the prudence of performing manipulation to the cervical spine as it relates to vertebral artery injury.     

Update on Spinal Mobilisations with Leg Movement

Abstract

A case study demonstrates the use of spinal mobilisations with leg movement to treat a patient who presented with low back pain and sciatica. A prone lying technique is demonstrated, however, the author is not suggesting that this new technique should replace the side lying method which was described in 1995. Both have a place in the treatment of patients with low back pain and sciatica.     

The Effects of Muscle Energy Technique on Lumbar Range of Motion

Abstract

This study examined whether the application of a muscle energy technique (MET) to the lumbar spine could significantly influence lumbar extension range of motion in an asymptomatic population. Twenty-six volunteer subjects, with limited range of motion in lumbar extension, were randomly assigned to either a control group or a treatment group. Thirteen subjects in the treatment group underwent eight sessions with the muscle energy technique, two times per week for 4 weeks. An independent group t test was used to analyze the data. The mean changes in scores, between pretest and posttest, were compared for both groups. Statistical significance was found at the p < .05 level indicating that the MET group significantly improved in lumbar extension range of motion.     

Quantification of Prone Thoracic Manipulation Using Inertial Sensor–Derived Accelerations

Objective

The aim of this study was to determine the linear acceleration, time-to-peak acceleration, and effect of hand position comparing 2 clinicians completing a thoracic manipulation.

Methods

Thirteen volunteers received a right- and left-“handed” prone thoracic manipulation while accelerations were recorded by an inertial sensor. Peak thrust acceleration and time-to-peak thrust were measured.

Results

There were differences in thrust acceleration between right- and left-handed techniques for one therapist. The mean peak thrust acceleration was different between therapists, with the more practiced therapist demonstrating greater peak thrust accelerations. Time-to-peak acceleration also revealed between therapist differences, with the more practiced therapist demonstrating shorter time-to-peak acceleration. Cavitation data suggested that manipulations with greater accelerations were more likely to result in cavitation.

Conclusion

The results of this study suggest that with greater frequency of use, therapists are likely to achieve greater accelerations and shorter time-to-peak accelerations. Furthermore, this study showed that an inertial sensor can be used to quantify important variables during thoracic manipulation and are able to detect intertherapist differences in technique.     

Effects of Anteroposterior Talus Mobilization on Range of Motion,Pain, and Functional Capacity in Participants With Subacute and Chronic Ankle Injuries: A Controlled Trial

Objective

The purpose of this study was to measure the acute (1 session) and chronic effects (6 sessions) and the follow-up (2 weeks) of anteroposterior articular mobilization of the talus, grade III of Maitland, on the dorsiflexion range of motion (ROM), pain, and functional capacity of individuals with subacute and chronic traumatic injuries of the ankle.

Chronic Mechanical Neck Pain in Adults Treated by Manual Therapy: A Systematic Review of Change Scores in Randomized Controlled Trials of a Single Session

We report a systematic analysis of group change scores of subjects with chronic neck pain not due to whiplash and without headache or arm pain, in randomized clinical trials of a single session of manual therapy. A comprehensive literature search of clinical trials of chronic neck pain treated with manual therapies up to December 2006 was conducted. Trials that scored above 60% on the PEDro Scale were included. Change scores were analyzed for absolute, percentage change and effect size (ES) whenever possible. Nine trials were identified: 6 for spinal manipulation, 4 for spinal mobilization or non-manipulative manual therapy (2 overlapping trials), and 1 trial using ischemic compression. No trials were identified for massage therapy or manual traction. Four manipulation trials (five groups) reported mean immediate changes in 100-mm VAS of −18.94 (9.28) mm. ES for these changes ranged from .33 to 2.3. Two mobilization trials reported immediate VAS changes of −11.5 and −4 mm (ES of .36 and .22, respectively); one trial reported no difference in immediate pain scores versus sham mobilization. The ischemic compression study showed statistically significant immediate decreases in 100-mm pain VAS (average = −14.6 mm). There is moderate-to-high quality evidence that immediate clinically important improvements are obtained from a single session of spinal manipulation. The evidence for mobilization is less substantial, with fewer studies reporting smaller immediate changes. There is insufficient evidence for ischemic compression to draw conclusions. There is no evidence for a single session of massage or manual traction for chronic neck pain.     

腰椎管狭窄症穹顶形减压术后早期下床活动对其疗效的影响

目的研究腰椎管狭窄症行穹顶形开窗减压术后2种不同时间下床活动对其疗效的影响,客观地获得下床活动的最佳时间。方法将80例采用穹顶形开窗减压术的腰椎管狭窄症患者随机分为实验组和对照组,各40例。实验组于术后第72 h、对照组于术后第10 d开始在腰围保护下下床活动,于术前、术后半年、术后一年对患者采用改良的日本骨科学会下腰痛评分法(简称M-JOA)进行评分,对两组的改善率进行比较。结果术后半年和术后一年,实验组与对照组的改善率差异均无统计学意义(P>0.01)。结论早期下床活动和晚期下床活动对近期疗效的影响均无差异,但早期下床活动可预防许多术后并发症,因此,应鼓励患者早期下床活动。     

Immediate Changes in Neck Pain Intensity and Widespread Pressure Pain Sensitivity in Patients With Bilateral Chronic Mechanical Neck Pain: A Randomized Controlled Trial of Thoracic Thrust Manipulation vs Non–Thrust Mobilization

Objective

The purpose of this study was to compare the effects of thoracic thrust manipulation vs thoracic non–thrust mobilization in patients with bilateral chronic mechanical neck pain on pressure pain sensitivity and neck pain intensity.

Methods

Fifty-two patients (58% were female) were randomly assigned to a thoracic spine thrust manipulation group or of thoracic non–thrust mobilization group. Pressure pain thresholds (PPTs) over C5-C6 zygapophyseal joint, second metacarpal, and tibialis anterior muscle and neck pain intensity (11-point Numerical Pain Rate Scale) were collected at baseline and 10 minutes after the intervention by an assessor blinded to group allocation. Mixed-model analyses of variance (ANOVAs) were used to examine the effects of the treatment on each outcome. The primary analysis was the group * time interaction.

Results

No significant interactions were found with the mixed-model ANOVAs for any PPT (C5-C6: P > .252; second metacarpal: P > .452; tibialis anterior: P > .273): both groups exhibited similar increases in PPT (all, P < .01), but within-group and between-group effect sizes were small (standardized mean score difference [SMD] < 0.22). The ANOVA found that patients receiving thoracic spine thrust manipulation experienced a greater decrease in neck pain (between-group mean difference: 1.4; 95% confidence interval, 0.8-2.1) than did those receiving thoracic spine non–thrust mobilization (P < .001). Within-group effect sizes were large for both groups (SMD > 2.1), and between-group effect size was also large (SMD = 1.3) in favor of the manipulative group.

Conclusions

The results of this randomized clinical trial suggest that thoracic thrust manipulation and non–thrust mobilization induce similar changes in widespread PPT in individuals with mechanical neck pain; however, the changes were clinically small. We also found that thoracic thrust manipulation was more effective than thoracic non–thrust mobilization for decreasing intensity of neck pain for patients with bilateral chronic mechanical neck pain.     

Lumbar stenosis rates in symptomatic patients using weight-bearing and recumbent magnetic resonance imaging

Objective

The purpose of this study was to determine the rate of lumbar stenosis detected via magnetic resonance imaging (MRI) in patients with symptomatic foraminal stenosis, lateral recess stenosis, or central stenosis.

Methods

A retrospective review was performed on 1983 MRI scans from a 2-year period on 1486 symptomatic patients. Of these patients, 761 were scanned in the recumbent position using low-field (0.3 T, Airis II; Hitachi, Twinsburg, Ohio) MRI, and 725 were scanned in an upright sitting position using midfield (0.6 T) open Upright MRI (Fonar Corp, Melville, NY). In total, 986 serial scans (recumbent) and 997 serial scans (weight-bearing) were performed.

Results

Of scans performed in the recumbent position, stenoses were identified in 382 scans (38.8%), central stenosis in 119 scans (12%), lateral recess stenosis in 91 scans (9.2%), and foraminal stenosis in 327 scans (33.2%). Of scans performed in a weight-bearing position, stenoses were identified in 565 scans (56.7%), central stenosis in 136 scans (13.6%), lateral recess stenosis in 206 scans (20.7%), and foraminal stenosis in 524 scans (52.6%).

Conclusions

The stenosis rates as indicated by MRI interpretation ranged between 38.5% (recumbent) and 56.7% (weight-bearing). These rates are higher than those reported in the medical literature for asymptomatic patients. Further study is needed to determine whether weight-bearing, compared with recumbent, MRI better informs the clinician in the diagnosis of spinal stenosis.     

Changes in bending stiffness and lumbar spine range of movement following lumbar mobilization and manipulation

Objective

The purpose of this study was to investigate the effects of lumbar rotational manipulation and lumbar central posteroanterior mobilization on lumbar bending stiffness and flexion and extension range of motion (ROM).

Methods

A same-subject, repeated-measures, crossover design was used using 32 asymptomatic subjects (16 female and 16 male; mean [SD] age, 25.5 [4.5] years; weight, 65.7 [11.8] kg; and height, 1.70 [0.08] m). Each subject received mobilization or manipulation on 2 different occasions. Bending stiffness was calculated using a 3-point bending model using an electromagnetic tracking device and a force platform; lumbar flexion and extension ROM was measured using an electromagnetic tracking device. All variables were measured pre- and postintervention. Their effect was compared using paired t tests.

Results

Manipulation and mobilization did not significantly alter either bending stiffness or lumbar flexion and extension ROM (mobilization: P = .175, P = .613, and P = .535; manipulation: P = .973, P = .323, and P = .439). Bending stiffness changes were not correlated to changes in ROM (Pearson r for stiffness-flexion = −0.102, P = .586; Pearson r for stiffness-extension = 0.014, P = .941).

Conclusions

Manipulation and mobilization had no significant effect on bending stiffness or flexion and extension ROM for this group of subjects. Some individual variations in effect were observed.     

后路椎弓根钉棒系统内固定椎间植骨术治疗腰椎滑脱伴椎管狭窄症

【目的】分析经后路椎弓根钉棒系统内固定椎间植骨（PLIF）治疗腰椎滑脱症的临床疗效【方法】采用后路椎弓根钉棒系统复位内固定,椎间及横突间植骨治疗28例腰椎滑脱症患者,从滑脱复位结果,融合成功率,术前术后疼痛改善情况,腰部功能改善以及并发症等方面进行评价。【结果】28例患者平均随访13个月,滑脱完全复位25例,占89．3％,不完全复位3例,占10．7％。全部患者都获得植骨融合,融合率100％。27例术后腰腿痛即消失。1例术后疼痛改善,1个月后疼痛消失。所有患者3个月后腰部活动良好。伸0°～20°,屈0°～40°,左侧弯0°～25°,右侧弯0°～25°。本组患者无钉棒松动或断裂,无神经损伤等并发症。【结论】采用后路椎板减压椎弓根钉棒系统内固定椎间植骨融合治疗腰椎滑脱,具有复位良好,融合可靠,疗效确切的特点,且减少了腰椎术后并发征的发生率。     

A Pilot Randomized Controlled Trial of Flexion-Distraction Dosage for Chiropractic Treatment of Lumbar Spinal Stenosis

Objective

The purpose of this pilot clinical trial was to assess the feasibility of recruiting older adults with lumbar spinal stenosis (LSS) into a clinical trial that used different dosages of flexion-distraction manipulation.

Methods

This randomized controlled trial used a 4-group design. Three groups consisted of chiropractic flexion-distraction manipulation applied at different dosages (8, 12, or 18 treatments). The fourth group was given 8 treatments of placebo care. Feasibility measures included recruitment goals, adherence to various treatment schedules, credibility of the placebo treatment, and rates of adverse events. The primary outcome measure was the Swiss Spinal Stenosis Questionnaire, a validated self-report of LSS symptom severity and physical function.

Results

The recruitment and adherence goals of the study were met with a total of 60 subjects randomized (n = 15 per group) and most subjects attending at least 75% of their scheduled visits. No adverse events were reported by any of the subjects in the trial. Our placebo treatment did not appear to be credible; most subjects correctly guessed that they were receiving a placebo treatment. Between-group effect size estimates were small, indicating larger samples are needed for future studies.

Conclusion

This pilot study showed that it is feasible to recruit patients with LSS and that most subjects will adhere to a 6-week treatment schedule. The information gained from this trial will be useful to inform the design of larger trials.     

The Immediate Effects of Mobilization Technique on Pain and Range of Motion in Patients Presenting With Unilateral Neck Pain: A Randomized Controlled Trial

Kanlayanaphotporn R, Chiradejnant A, Vachalathiti R. The immediate effects of mobilization technique on pain and range of motion in patients presenting with unilateral neck pain: a randomized controlled trial.

Objective

To determine the immediate effects on both pain and active range of motion (ROM) of the unilateral posteroanterior (PA) mobilization technique on the painful side in mechanical neck pain patients presenting with unilateral symptoms.

Design

Triple-blind, randomized controlled trial.

Setting

Outpatient physical therapy, institutional clinic.

Participants

Patients (N=60), 2 physical therapists, and 1 assessor involved in this study.

Interventions

The patients were randomly allocated into either preferred or random mobilization group by using an opaque concealed envelope. The first therapist performed the screening, assessing, prescribing the spinal level(s), and the grade of mobilization. The second therapist performed the mobilization treatment according to their allocated group stated in an envelope. The assessor who was blind to the group allocation conducted the measurements of pain and active cervical ROM.

Main Outcome Measures

Pain intensity, active cervical ROM, and global perceived effect were measured at baseline and 5 minutes posttreatment.

Results

After mobilization, there were no apparent differences in pain and active cervical ROM between groups. However, within-group changes showed significant decreases in neck pain at rest and pain on most painful movement (P<0.001) with a significant increase in active cervical ROM after mobilization on most painful movement (P=0.002).

Conclusions

The results of this study did not provide support for the preference of the unilateral PA mobilization on the painful side to the random mobilization.     

腰椎侧隐窝狭窄及其临床意义(附365例临床与CT分析)

本文总结了365例非外伤性腰腿痛病人的CT所见。指出腰椎侧隐窝狭窄、椎小关节病变和腰椎间盘病变是最常见的征象。本组出现率分别为78.6％、72.6％和53.6％。作者强调腰椎侧隐窝狭窄主要是因椎小关节和(或)椎间盘一系列病理性变化所产生的一个重要征象。侧隐窝狭窄使通过的脊神经受阻是引起腰腿痛的直接原因之一,它与椎小关节和(或)椎间盘病变有着密切的联系。     

Midline synovial and ganglion cysts causing neurogenic claudication

Typically situated posterolateral in the spinal canal, intraspinal facet cysts often cause radicular symptoms. Rarely, the midline location of these synovial or ganglion cysts may cause thecal sac compression leading to neurogenic claudication or cauda equina syndrome. This article summarizes the clinical presentation, radiographic appearance, and management of three intraspinal, midline facet cysts. Three patients with symptomatic midline intraspinal facet cysts were retrospectively reviewed. Documented clinical visits, operative notes, histopathology reports, and imaging findings were investigated for each patient. One patient presented with neurogenic claudication while two patients developed partial, subacute cauda equina syndrome. All 3 patients initially responded favorably to lumbar decompression and midline cyst resection; however, one patient required surgical stabilization 8 mo later. Following the three case presentations, we performed a thorough literature search in order to identify articles describing intraspinal cystic lesions in lateral or midline locations. Midline intraspinal facet cysts represent an uncommon cause of lumbar stenosis and thecal sac compression. Such entities should enter the differential diagnosis of midline posterior cystic lesions. Midline cysts causing thecal sac compression respond favorably to lumbar surgical decompression and cyst resection. Though laminectomy is a commonly performed operation, stabilization may be required in cases of spondylolisthesis or instability.     

Effectiveness of Mulligan’s mobilization with movement techniques on pain and disability of peripheral joints: a systematic review with meta-analysis between 2008–2017

Background

The Mulligan method of manual therapy advocates the use of ‘mobilization with movement (MWM)’ techniques to effectively manage peripheral joint ‘positional fault’ dysfunctions.

非X光胃镜直视下金属支架治疗食管恶性狭窄疗效观察

目的;使用金属支架治疗恶性狭窄。方法：在非X光胃镜直视下放置镍钛记忆合金支架治疗食管恶性狭窄33例,其中食管癌所致食管狭窄25例（肿块型9例,四周狭窄型16例）,食管贲门癌术后复发吻合口狭窄6例,肺癌转移食管并狭窄2例。术后给予治疗和／或化疗。结果：本组病例放置成功率100％,术中无食管出血及食管破裂等并发症发生,术后咽下困难、梗噎感、食管反流消失。术后与术前比较,吞咽困难明显改善达两个级别以上,经统计学处理有显著性差异,P＜0．01。结论：非X光胃镜下直视下置入金属支架治疗食管癌恶性狭窄安全、可靠,治疗效果显著,对于提高人病人生活质量,延长病人生存时间不失为一种行这有效、姑息性的治疗方法,术后放疗和／或化疗效果更佳。